Waiting on a white knight

Ever since CMS announced that HME suppliers must be accredited to participate in competitive bidding, the prevailing assumption has been that suppliers would rush the doors of accrediting houses and that those houses would see spikes in the number of HMEs seeking accreditation. Some expected an Oklahoma Land Rush, but did anyone suspect the relatively lackadaisical approach to accreditation that unaccredited suppliers seem to be taking? "In terms of a spike, we haven't seen one," says JCAHO's Maryanne Popovich. Now that CMS has whittled its list of prospective targets for 2007 from 25 cities to 19, one would have expected the comments from accreditors to be otherwise. Certainly, the accreditors anticipated a rush; they doubled and tripled office space and staffed up significantly to handle one. They built it, but few are coming. Why? This headline might help explain: "Industry stakeholders consider NCB repeal" (See HME News February 2007). This industry likes its white knights. Nobody wants to rule out salvation from Congress and the disappearance of competitive bidding altogether. Are suppliers watching and waiting and hoping? We all know, of course, that this kind of procrastination is pennywise and pound foolish. But maybe it's not altogether surprising. We know there are far more dealers than providers out there. I use dealer as a pejorative term here. A dealer is a business person who is tangentially interested in what's happening to the industry and its long-term health, and very interested in the opportunity to bill Medicare today. The National Supplier Clearinghouse has granted more than 100,000 supplier numbers to businesses that bill Medicare for durable medical equipment. And yet, the circulation of this publication and others in this industry represents a mere one-tenth of that number. At AAHomecare, the numbers are worse: Membership there is only about one-tenth of the circulation of a trade publication. If you don't care to join a trade group or read a trade pub to stay abreast of your business, that says something about how you run your business. (It's easy to slam these guys here; I know they're not reading.) So it's not surprising that they wouldn't be rushing to become accredited. Maybe they don't even know they have to be accredited! All along, CMS has been trying to address the problem of the Great Unwashed dealer base. Indeed, the roots of competitive bidding sprung from a desire to contain fraud and abuse. We don't care much about the great unwashed mass of dealers who don't get accredited. But if you belong to the other camp, and you're waiting for the white knight, it's time to stop dreaming. You can hope, but it doesn't pay to dream--especially if you live in a big metropolitan area.